Job Description:

Supports the direction and coordination of medical affairs to include quality management, utilization management, case management, and preventive health services. Provides direct assistance to the Medical Director. Requires a medical degree from an accredited medical school and a license to practice. Experience in a managed health plan is typically desired. Reviews and makes determinations on all questionable physician review decisions. Assists in the development of clinical practice guidelines or case management guidelines. Participates in the review and approval of inter-rater reliability monitoring. Provides medical input into the development of preventive health, quality improvement, and utilization management activities. Assists with the analysis of provider profiles to identify areas for improvement. Serves as an interface in professional or institutional matters between the plan and its providers. May conduct provider profile consultation visits. Less

Supports the direction and coordination of medical affairs to include quality management, utilization management, case management, and preventive health services. Provides direct assistance to the Medical Director. Requires a medical degree from an accredited medical school and a license to... More